The notice and claim required under the provisions of section 656 of this title shall be in writing. Such notice shall contain the name and address of the employee; shall state in ordinary language the time, place, nature, and cause of the injury; and shall be signed by the employee or by a person in his or her behalf, or, in the event of his or her death, by any one or more of his or her dependents or by a person in their behalf. The notice and the claim may be combined.
Vt. Stat. Ann. tit. 21, § 658
Form of notice and claim
Official source: Vermont General Assembly. Reproduced from public-domain Vermont statutes; confirm against the official source for the current text. Not legal advice.